Performance assessment of intravenous catheters for massive transfusion: A pragmatic in vitro study

BACKGROUND: Rapid infusion of warmed blood products is the cornerstone of trauma resuscitation and treatment of surgical and obstetric massive hemorrhage. Integral to optimizing this delivery is selection of an intravenous (IV) catheter and use of a rapid infusion device (RID). We investigated which IV catheter and RID system enabled the greatest infusion rate of blood products and the governing catheter characteristics. STUDY DESIGN AND METHODS: The maximum flow rates of nine IV catheters were measured while infusing a mixture of packed red blood cells and fresh frozen plasma at a 1:1 ratio using a RID with and without a patient line extension. To account for IV catheters that achieved the RID\u27s maximum 1000 ml/min, the conductance of each infusion circuit configuration was calculated. RESULTS: IV catheters of 7-Fr caliber or higher reached the maximum pressurized flow rate. The 9-Fr multi-lumen access catheter (MAC) achieved the greatest conductance, over sevenfold greater than the 18 g peripheral catheter (4.6 vs. 0.6 ml/min/mmHg, p \u3c .001). Conductance was positively correlated with internal radius (β = 1.098, 95% CI 4.286-5.025, p \u3c .001) and negatively correlated with length (β= - 0.495, 95% CI -0.007 to 0.005, p \u3c .001). Use of an extension line (β= - 0.094, 95% CI -0.505 to -0.095, p = .005) was independently associated with reduced conductance in large caliber catheters. CONCLUSION: Short, large-diameter catheters provided the greatest infusion rates of massive transfusion blood products for the least pressure. For patients requiring the highest transfusion flow rates, extension tubing should be avoided when possible

Rapid aqueous photo-polymerization route to polymer and polymer-composite hydrogel 3D inverted colloidal crystal scaffolds

Successful regeneration of biological tissues in vitro requires the utilization of three-dimensional (3D) scaffolds that provide a near natural microenvironment for progenitor cells to grow, interact, replicate, and differentiate to form target tissues. In this work, a rapid aqueous photo-polymerization route was developed toward the fabrication of a variety of polymer hydrogel 3D inverted colloidal crystal (ICC) scaffolds having different physical and chemical properties. To demonstrate the versatility of this technique, a variety of polymer hydrogel ICC scaffolds were prepared, including (1) polyacrylamide (pAAM) scaffolds, (2) poly(2-hydroxyethyl methacrylate) (pHEMA) scaffolds, (3) poly(2-hydroxyethyl acrylate) (pHEA) scaffolds, and composite scaffolds including (4) pAAM-pHEMA scaffolds, (5) pHEMA-pMAETAC [poly(2-methacryloyloxy) trimethyl ammonium] scaffolds, and (6) pHEA-pMEATAC scaffolds. Templates for scaffolds incorporated both uniform sized (104 Μm diameter) and nonuniform sized (100 ± 20 Μm diameter) closely packed noncrosslinked poly(methyl methacrylate) beads. Human bone marrow stromal HS-5 cells were cultured on the six different types of scaffolds to demonstrate biocompatibility. Experimental results show that cells can remain viable in these scaffolds for at least 5 weeks. Of the six scaffolds, maximal cell adhesion and proliferation are obtained on the positively charged composite hydrogel pHEMA-pMEATAC and pHEA-pMAETAC scaffolds. © 2007 Wiley Periodicals, Inc. J Biomed Mater Res, 2007Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/56168/1/31199_ftp.pd

Loss of MECP2 Leads to Activation of P53 and Neuronal Senescence.

To determine the role for mutations of MECP2 in Rett syndrome, we generated isogenic lines of human induced pluripotent stem cells, neural progenitor cells, and neurons from patient fibroblasts with and without MECP2 expression in an attempt to recapitulate disease phenotypes in vitro. Molecular profiling uncovered neuronal-specific gene expression changes, including induction of a senescence-associated secretory phenotype (SASP) program. Patient-derived neurons made without MECP2 showed signs of stress, including induction of P53, and senescence. The induction of P53 appeared to affect dendritic branching in Rett neurons, as P53 inhibition restored dendritic complexity. The induction of P53 targets was also detectable in analyses of human Rett patient brain, suggesting that this disease-in-a-dish model can provide relevant insights into the human disorder

Neurophysiology of epidurally evoked spinal cord reflexes in clinically motor-complete posttraumatic spinal cord injury

Increased use of epidural Spinal Cord Stimulation (eSCS) for the rehabilitation of spinal cord injury (SCI) has highlighted the need for a greater understanding of the properties of reflex circuits in the isolated spinal cord, particularly in response to repetitive stimulation. Here, we investigate the frequency-dependence of modulation of short- and long-latency EMG responses of lower limb muscles in patients with SCI at rest. Single stimuli could evoke short-latency responses as well as long-latency (likely polysynaptic) responses. The short-latency component was enhanced at low frequencies and declined at higher rates. In all muscles, the effects of eSCS were more complex if polysynaptic activity was elicited, making the motor output become an active process expressed either as suppression, tonic or rhythmical activity. The polysynaptic activity threshold is not constant and might vary with different stimulation frequencies, which speaks for its temporal dependency. Polysynaptic components can be observed as direct responses, neuromodulation of monosynaptic responses or driving the muscle activity by themselves, depending on the frequency level. We suggest that the presence of polysynaptic activity could be a potential predictor for appropriate stimulation conditions. This work studies the complex behaviour of spinal circuits deprived of voluntary motor control from the brain and in the absence of any other inputs. This is done by describing the monosynaptic responses, polysynaptic activity, and its interaction through its input–output interaction with sustain stimulation that, unlike single stimuli used to study the reflex pathway, can strongly influence the interneuron circuitry and reveal a broader spectrum of connectivity

Riesgos percibidos e intención de compra online de prendas de vestir por marketplace de los usuarios de Facebook Trujillo 2021

La investigación tuvo como objetivo determinar la relación entre los riesgos percibidos y la intención de compra online de prendas de vestir por Marketplace de los usuarios de Facebook Trujillo 2021. Fue una investigación de tipo aplicada, de diseño no experimental, de corte transversal y de nivel correlacional. La población estuvo conformada por los usuarios de Facebook de Trujillo de entre 18 a 70 años de edad que ingresaron alguna vez a interactuar a la sección marketplace de Facebook, con una muestra de 197. Se aplicó la técnica de la encuesta y el instrumento empleado fue un cuestionario online, del cual se obtuvieron datos que fueron procesados en SPSS Statistics v.25. El principal resultado fue determinado mediante aplicación del Rho de Spearman, del cual se obtuvo un coeficiente de correlación de -0.464 que evidencia una relación indirecta moderada entre las variables de estudio. Asimismo, se obtuvo un valor de significancia de 0.000 menor al margen de error de 0.05, el cual indica que la relación es altamente significativa. En suma, los riesgos percibidos sí se relacionan con la intención de compra online de prendas de vestir por marketplace de los usuarios de Facebook Trujillo 2021

Notes on bird species in bamboo in northern Madre de Dios, Peru, including the first Peruvian record of acre tody-tyrant (\u3cem\u3eHemitriccus cohnhafti\u3c/em\u3e)

In the southwestern Amazon Basin, large areas of habitat are comprised predominantly of Guadua bamboo. Many bird species occur in or specialize on Guadua-dominated habitats, but little is known about the taxonomy, distribution, and evolutionary history of this avian assemblage. During 2011, we surveyed the surroundings of Iberia, an area with many large Guadua stands in the southern Peruvian Amazon. We found many Guadua specialist bird species and discovered a surprising Andean element to the local avifauna. We present information on Guadua specialists, Andean species, birds of open habitats, and avian migration and reproduction. We provide accounts for species of particular interest and an appendix containing an annotated list of all species detected

Safety and visual outcomes following posterior chamber phakic intraocular lens bilensectomy

To evaluate the safety, efficacy, refractive outcomes and causes for bilensectomy (phakic intraocular lens - pIOL - explantation with cataract surgery and pseudophakic intraocular lens implantation) in patients previously implanted with posterior chamber pIOLs. This multi-center retrospective study included 87 eyes of 55 patients who underwent bilensectomy for posterior chamber pIOL with a follow up time of 12 months. The uncorrected and best corrected distance visual acuities (UDVA, CDVA), endothelial cell density before and after bilensectomy were assessed, as well as the cause of bilensectomy and intra or postoperative complications. There was a statistically significant improvement in uncorrected and best corrected visual acuities after bilensectomy (p = 0.00). The main reason for bilensectomy was cataract development (93.1% of the cases), followed by miscalculation of lens size, and corneal edema. The endothelial cell count remained stable without a statistically significant change after surgery (p = 0.67). The refractive efficacy index was 0.8, none of the patients lost lines of CDVA after surgery, 73% of the patients were within ±1 D (spherical equivalent) of the target refraction. Intraoperative complications were one posterior capsule rupture with the intraocular lens (IOL) implanted in the sulcus, and 3 eyes required the use of pupil expanders for adequate pupil dilation. Postoperatively, one eye developed retinal detachment. The three pIOLs models explanted were the Implantable Collamer Lens (ICL), Implantable Phakic Contact Lens (IPCL) and the Phakic Refractive Lens (PRL). Good safety and visual outcomes were observed 1 year after bilensectomy for posterior chamber phakic intraocular lenses (PC pIOLs). There were few intra and postoperative complications and there was no significant endothelial cell loss after the bilensectomy procedure

NÚMERO ÁUREO: introduzindo o número áureo no dia a dia do aluno

A presente pesquisa tem por objetivo despertar o interesse do aluno na matemática, através do número áureo. Conhecido também como número de ouro, o número áureo está diretamente ligado aos padrões de beleza ao divino, é encontrado na arquitetura, na arte e até mesmo na natureza. Baseando-se no conceito do número áureo, formas de aplicação e atividades, pode-se trabalhar muitos conteúdos do currículo escolar, como exemplo: álgebra, proporções, equações, entre outros. Devido a essa capacidade de abordar diversos conteúdos, consegue-se atingir alunos desde o ensino fundamental até os alunos de ensino médio

Predicting Individual Treatment Response to rTMS for Motor Recovery After Stroke: A Review and the CanStim Perspective

BackgroundRehabilitation is critical for reducing stroke-related disability and improving quality-of-life post-stroke. Repetitive transcranial magnetic stimulation (rTMS), a non-invasive neuromodulation technique used as stand-alone or adjunct treatment to physiotherapy, may be of benefit for motor recovery in subgroups of stroke patients. The Canadian Platform for Trials in Non-Invasive Brain Stimulation (CanStim) seeks to advance the use of these techniques to improve post-stroke recovery through clinical trials and pre-clinical studies using standardized research protocols. Here, we review existing clinical trials for demographic, clinical, and neurobiological factors which may predict treatment response to identify knowledge gaps which need to be addressed before implementing these parameters for patient stratification in clinical trial protocols.ObjectiveTo provide a review of clinical rTMS trials of stroke recovery identifying factors associated with rTMS response in stroke patients with motor deficits and develop research perspectives for pre-clinical and clinical studies.MethodsA literature search was performed in PubMed, using the Boolean search terms stroke AND repetitive transcranial magnetic stimulation OR rTMS AND motor for studies investigating the use of rTMS for motor recovery in stroke patients at any recovery phase. A total of 1,676 articles were screened by two blinded raters, with 26 papers identified for inclusion in this review.ResultsMultiple possible factors associated with rTMS response were identified, including stroke location, cortical thickness, brain-derived neurotrophic factor (BDNF) genotype, initial stroke severity, and several imaging and clinical factors associated with a relatively preserved functional motor network of the ipsilesional hemisphere. Age, sex, and time post-stroke were generally not related to rTMS response. Factors associated with greater response were identified in studies of both excitatory ipsilesional and inhibitory contralesional rTMS. Heterogeneous study designs and contradictory data exemplify the need for greater protocol standardization and high-quality controlled trials.ConclusionClinical, brain structural and neurobiological factors have been identified as potential predictors for rTMS response in stroke patients with motor impairment. These factors can inform the design of future clinical trials, before being considered for optimization of individual rehabilitation therapy for stroke patients. Pre-clinical models for stroke recovery, specifically developed in a clinical context, may accelerate this process

A Novel STAT3 Mutation in a Qatari Patient With Hyper-IgE Syndrome

Autosomal dominant hyper-IgE syndrome caused by mutations in the transcription factor STAT3 (AD-HIES) is characterized by a collection of immunologic and non-immune features including eczema, recurrent infections, elevated IgE levels, and connective tissue anomalies. We report the case of a Qatari child with a history of recurrent staphylococcal skin infections since infancy, who was found to have a novel, de novo mutation in STAT3 (c.1934T>A, p.L645Q). The absence of mucocutaneous candidiasis and undetectable IgE levels until the age of 7 years prolonged the time to molecular confirmation of the cause for the patient's immune deficiency. STAT3 p.L645Q was found to have decreased transcriptional capacity. The patient also had low levels of Th17 cells and STAT3 phosphorylation was impaired in patient-derived cells. Nearly 100 unique mutations in STAT3 have been reported in association with AD-HIES